S. 4141 — Rural Hospital Revitalization Act of 2026

This section establishes the Rural Hospital Revitalization Loans program under the USDA community facilities direct loan program (section 306(a)(1) of the Consolidated Farm and Rural Development Act), which provides affordable financing to rural areas for essential community facilities such as hospitals. (a) The Secretary must make temporary zero-percent interest loans to eligible rural hospitals for constructing replacement hospital facilities or improving or renovating existing facilities. (b) Eligible rural hospitals are those (1) with a campus in a county of less than 20,000 population; (2) whose campus is at least 35 miles (or 15 miles in mountainous terrain or on secondary roads) from the nearest hospital, or that qualify as a critical access hospital or rural emergency hospital under the Social Security Act; (3) continuously licensed in their community for at least 30 years; (4) that apply with demonstrations of facility need (excluding recently improved facilities), positive community health and economic impacts, and projected loan benefits; and (5) financially stable with at least 30 days cash on hand and a projected debt service coverage ratio of 1.2 (waivable for strong community impacts). The Secretary must prioritize hospitals (1) serving areas with fewer than 6 inhabitants per square mile (considering distance, travel time, and seasonal needs); (2) needing unaffordable improvements under standard program terms; (3) with at least 50% of recent inpatient days/discharges and outpatient visits from Medicare, Medicaid, or self-pay patients; or (4) meeting two or more such criteria—and deems eligible hospitals as qualifying for the community facilities direct loan program. (c) Loans are interest-free for the first five years, with principal repaid over five years and amortized per program standards over the lesser of the facility's expected life or 40 years; the Secretary must assess financial stability at the end of that period.